The NHS is a health system not a charity. It should be funded accordingly – by Rebecca Richards
He walked his way into the hearts of a nation – one lap of his garden at a time. In doing so, 100-year-old – soon to be Sir – Captain Tom Moore raised a staggering £29million for the NHS. While perhaps the most publicised, he is not the only private citizen helping the NHS respond to the Covid-19 pandemic. The ‘Run for Heroes’ Challenge – whereby social media users run 5km, donate £5, and nominate five of their friends to do the same – has raised more than £5million in less than a month. And all over the country, people are sewing Personal Protective Equipment (PPE) for frontline healthcare workers that are lacking adequate safety equipment.
But the heart-warming response these extraordinary feats of solidarity and good-will elicit in us can also obscure the fact that the NHS should not need this level of support. As an anonymous NHS doctor recently pointed out, ‘The NHS is not a charity’. The NHS is a healthcare system. It is therefore the government’s responsibility to fund, staff, and supply it so that it can effectively respond to a pandemic that was not entirely unexpected.  It is a responsibility the government has arguably failed to fulfill adequately. Though not alone in its enforcement of austerity measures over the past decades,  the government’s economic policies left the NHS under pressure even before the pandemic broke out. Between 2010 and 2014, for example, the real-term annual increase in NHS England funding was only 1.3%, down from historical annual growth rates of approximately 4%. This has been associated with nearly 120,000 preventable deaths in England during this time period. And though the government committed to increasing NHS funding in 2018, this – and subsequent government funding increases – has not been enough to ‘reverse years of health underfunding’.
When the magnitude of the Covid-19 crisis became clear, the NHS was therefore not fully prepared. After missing the deadline to participate in a EU collective-buying scheme to source additional ventilators,the government is making slow progress in procuring the necessary 18,000 ventilators – down from an original estimate of 30,000. The government asked retired NHS staff to come out of retirement to support the relief effort – a call that more than 20,000 people answered. There is also an ongoing shortage of PPE in large parts of the country – despite the Health Secretary’s request to health workers to not ‘overuse’ PPE.
All of this is not to say that the UK is the only country struggling to buttress its health system against a worldwide pandemic. Pandemic responses are notoriously complex and difficult to ‘get right’ and the government has committed to a further £6 billion boost to the NHS. Nor am I diminishing the incredible efforts of volunteers and donors that are providing invaluable support to the NHS and its staff and their families. The point I am making is that this level of fundraising, volunteering, and coming out of retirement should not be necessary to prop up the health system of one of the richest countries in the world.
As the saying goes, tragedy can bring out the best in people. But, as Polly Palliser-Wilkins put it, it – tragedy – can also work ‘to individualise events and mask the reasons or the responsibility for such incidents, fixing them in space and time and casting them adrift from their structural causes and politics’. We need to be careful that the outpouring and mobilisation of support we have seen does not ‘obscure the political failures that underpin the crisis itself’.[19, p.22] To truly learn from this pandemic and hold governments accountable for their responsibilities to protect us from it, we must not view acts of support as the isolated actions of individuals, totally separate from the context in which they are required. As Palliser-Wilkins argues, humanitarian assistance to times of crises is in itself political because of its ‘relationship to the failure of politics’.[19, p.23] And this particular failure is one not worth repeating.
 ‘Coronavirus: Captain Tom Moore gets Royal Mail birthday postmark‘, (BBC News, 27 April 2020).
 M. Blackall, ‘The volunteers making PPE on the homefront for UK health workers‘, The Guardian (23 April 2020).
 Anonymous, ‘I’m an NHS doctor – and I’ve had enough of people clapping for me‘, The Guardian (21 May 2020).
 S. Scutti, ‘World Health Organization gets ready for “Disease X”‘, (CNN, 12 March 2018).
 D. Mercer, ‘Coronavirus outbreak could be feared “Disease X”, says World Health Organisation adviser‘, (Skynews, 25 February 2020).
 D. Stuckler and others, ‘Austerity and health: the impact in the UK and Europe’, (2017) European Journal of Public Health, 27(suppl_4), 18-21.
 ‘Britain’s NHS needs more than plaudits to beat Covid-19‘, (Financial Times, 1 April 2020).
 J. Watkins and others, ‘Effects of health and social care spending constraints on mortality in England: a time trend analysis’, (2017) BMJ Open, 7(11).
 A. Sparrow, ‘Johnson’s £1.8bn for NHS welcome but not enough, say health experts‘, The Guardian (4 August 2019).
 R. Mason and L. O’Carroll, ‘No 10 claims it missed deadline for EU ventilator scheme‘, The Guardian (26 March 2020).
 R. Davies, ‘How close is the NHS to getting the 18,00 ventilators it needs?‘, The Guardian (14 April 2020).
 ‘Coronavirus: Tens of thousands of retired medics asked to return to NHS‘, (BBC News, 20 March 2020).
 S. Blewett, ‘Coronavirus: 20,000 retired NHS staff have returned to fight Covid-19, Johnson says‘, The Independent (30 March 2020).
 H. Stewart and D. Campbell, ‘NHS workers angered at Hancock’s warning not to overuse PPE‘, The Guardian (10 April 2020).
 ‘Chancellor provides over £14 billion for our NHS and vital public services‘, (GOV.UK, 13 April 2020).
 P. Pallister-Wilkins, ‘Humanitarian Rescue/Sovereign Capture and the Policing of Possible Responses to Violent Borders’, (2017) Global Policy, 8, 19-24, 20.
Rebecca Richards is the Postgraduate Research Assistant on Dr. Ganguli-Mitra’s Wellcome Trust Seed Award Project entitled ‘Justice and Vulnerability in Global Health Emergency Regulation: Developing Future ethical models’ at the University of Edinburgh School of Law.